In 2018, AHRQ-funded researchers published over 100 research articles in peer-reviewed journals and book chapters, including the following:
Development and Dissemination of a Novel Quality Improvement Framework to Improve Care for Children in the ICU
Dr. Anping Xie and colleagues developed and implemented a quality improvement framework to reduce unnecessary blood culture testing for critically ill children in the intensive care unit (ICU). A five-part improvement framework was implemented in three pediatric ICUs and included: 1) a work system assessment conducted during an initial site visit, 2) identification of multidisciplinary stakeholders and a project champion, 3) collection and sharing of blood culture data, 4) adaptation of clinician support tools by each unit, and 5) communication and analysis of progress throughout the implementation process.
Across the three units, blood culture rates significantly decreased by 32 percent, and the rate of cultures drawn from central venous catheters decreased by 51 percent. Different approaches were followed at the three units including the identity (i.e., staff role) and involvement of the champion, adaption of clinical tools, and the monitoring and communication of progress.
Use of a mHealth App Can Reduce College Students Hazardous Drinking
Researcher Dr. Donna Kazemi and her colleagues developed a smartphone app, “SmarTrek,” designed to reduce risky alcohol use in college students. SmarTrek includes eight components that address alcohol use, including interactive games, a feature around blood alcohol content, a daily log, a virtual coach, a “My Strategies” section, the ability to receive personalized feedback, and a resources section. The app’s interactive components, including text messages, incorporated motivational interviewing to facilitate behavior change and ecological momentary interventions (EMI). EMI uses technology to send information to an individual during risky behavior when there is the greater opportunity to promote healthy behaviors. The investigators found 90 percent of participants thought that the app was easy to use, provided useful information, and had a positive effect on reducing their drinking.
Understanding How Physicians Help Patients Deal with Chronic Pain
In the United States, the complexities of caring for patients with chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. Chronic pain leads to reduced quality of life for patients and strains health systems in the Nation. Dr. Christopher Harle and his team at Indiana University–Purdue University, Indianapolis (IUPUI), are developing EHR-integrated decision support tools with the goal of increasing the quality and effectiveness of chronic pain care. To help inform their work, the team interviewed 10 primary care clinicians about 30 patients with chronic pain. They identified several patient, social/environmental, and clinician factors that influence clinicians’ assessment of their patients to determine a pain management plan. Significant ambiguity and uncertainty in clinical pain management decision making was identified. Therefore, interventions to improve pain care should focus on providing context of clinical evidence rather than providing clinicians with decontextualized and/or algorithm-based decision rules.
AHRQ Health IT-funded research featured in Health Affairs patient safety issue
The November 2018 issue of Health Affairs, “Patient Safety,” includes a comprehensive look at the best and latest patient safety research. Almost 20 years after the publication of the landmark IOM report, the issue’s articles examine the significant progress that has been made in the intervening years and the barriers still in place. The journal issue and the accompanying event5 in November 2018 brought together many of the authors; explored the emerging issues in patient safety; and discussed what gaps remain in research, policy, and implementation to reduce patient harm. The articles explore a broad range of safety initiatives, including the use of health IT to reduce medication errors and emerging efforts to improve diagnoses. The research of Drs. Ratwani and Schiff, who also participated in the event, was featured in this issue.
5 “Patient Safety, " Health Affairs Event, November 6, 2018. W Hotel Washington. DOI: 10.1377/he20181024.13806. available at: https://www.healthaffairs.org/do/10.1377/he20181024.13806/full/